<form id="edit-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Agent_name')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-agent_name" class="form-control" name="row[agent_name]" type="text" value="{$row.agent_name|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Day_user')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-day_user" data-rule="required" class="form-control" name="row[day_user]" type="number" value="{$row.day_user|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Day_ip_num')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-day_ip_num" data-rule="required" class="form-control" name="row[day_ip_num]" type="number" value="{$row.day_ip_num|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Day_rechage_num')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-day_rechage_num" data-rule="required" class="form-control" name="row[day_rechage_num]" type="number" value="{$row.day_rechage_num|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Day_price')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-day_price" data-rule="required" class="form-control" step="0.01" name="row[day_price]" type="number" value="{$row.day_price|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Date')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-date" class="form-control" name="row[date]" type="number" value="{$row.date|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Create_time')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-create_time" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[create_time]" type="text" value="{:$row.create_time?datetime($row.create_time):''}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Agent_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-agent_id" data-rule="required" data-source="agent/index" class="form-control selectpage" name="row[agent_id]" type="text" value="{$row.agent_id|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('P_agent_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-p_agent_id" data-rule="required" data-source="p/agent/index" class="form-control selectpage" name="row[p_agent_id]" type="text" value="{$row.p_agent_id|htmlentities}">
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-success btn-embossed disabled">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>
